Older and Younger Women Have Similar Outcomes After Breast Reconstruction

Many, but not all, women who have mastectomy to treat breast cancer go on to have one or both breasts reconstructed. There are many ways to reconstruct a breast. Tissue from the back, belly, buttocks, or other part of the body can be used to create a new breast. Doctors call this autologous reconstruction. Saline or silicone gel implants are another option.

More than 40% of new breast cancer diagnoses are in women older than 60. Because many people think older women are not good candidates for reconstruction, researchers wondered if older women had more complications after breast reconstruction or got different benefits from the procedure than younger women.

A study suggests that older and younger women benefit equally from breast reconstruction and that age shouldn’t disqualify a woman from having reconstruction.

To do the study, the researchers looked at the outcomes of 1,531 women who were part of the Mastectomy Reconstruction Outcomes Consortium study that was done at 11 institutions in North America:

494 were younger than 45; these women were classified as “younger women”

803 were age 45 to 60; these women were classified as “middle-aged women”

234 were older than 60; these women were classified as “older women”

The women had reconstruction between February 2012 and July 2016.

The researchers looked at rates of any type of complication after reconstruction, including capsular contracture (the hardening of the tissue capsule around an implant), hernia or muscle weakness at the donor site for autologous reconstruction, or tissue breakdown with any type of reconstruction. The researchers also used a survey tool to collect the women’s perceptions of their psychosocial, physical, and sexual well-being after breast reconstruction.

The results showed that complication rates varied by type of reconstruction, but age had no influence on whether a woman would have complications after reconstruction surgery.

For women who had implant reconstruction, complication rates were:

22% for younger women

27% for middle-aged women

29% for older women

For women who had autologous reconstruction, major complication rates were:

33% in younger women

29% in middle-aged women

31% in older women

Looking at psychosocial, physical, and sexual well-being after reconstruction, the researchers again found that age had no effect. Still, older women who had implant surgery were slightly less satisfied with their breasts after reconstruction. All other groups of women were just as satisfied with their breasts after reconstruction as they were before the surgery.

"Surgeons and patients may have preconceived notions that breast reconstruction is not as good an option in older women as it is in younger patients," said Edwin Wilkins, M.D., professor of surgery at the University of Michigan, who was the study’s principal author. "According to findings from this study, reconstruction provided the benefits it was expected to provide for quality of life and body image, and age did not significantly affect complications."

Deciding whether to have a breast reconstructed after surgery to remove breast cancer is a very personal choice. If you’ve been diagnosed with breast cancer and are planning your surgery, you may decide not to have reconstruction, but it can be helpful to consider all your options.

Here are some questions you might want to think about as you're making your decision about breast reconstruction:

Is it important to you to have a permanent breast shape? Some women prefer to wear a prosthesis instead of having reconstruction.

Is it important to you that your breasts look balanced when wearing a bra and bathing suits? Though you'll be able to see the difference between the rebuilt breast and your other breast when you're naked, reconstruction usually looks very natural when you're wearing a bra or bathing suit.

In your unique situation, will breast reconstruction involve several surgeries over a long period of time? For many women, the answer is yes.

Will your insurance pay for all the reconstruction procedures? Find out what your insurance company will cover.

Did you have a lumpectomy that gave your breast a very different shape than it originally had? If you had a large portion of tissue removed, you might want to have reconstruction to restore a more balanced look.

Do you have any other medical conditions that might affect your ability to heal after surgery? If you have diabetes, circulatory problems, or a bleeding disorder, it may take your body longer to heal from reconstruction surgery than someone who doesn't have these conditions.

Do you have a condition that might give you a distorted image of your body? If you've been diagnosed with anorexia or bulimia, you may have a hard time accepting how your body looks in general, which may make it hard to accept how your reconstructed breast looks.

For more information, including types of reconstruction and the timing of reconstruction, visit the Breastcancer.org Breast Reconstruction section.